Protected PCI Protocols Introduced Across the UH System
June 25, 2019
UH is first to promote system-wide protocols and hire dedicated coordinatorPatients with coronary artery disease (CAD) very often are offered percutaneous coronary intervention (PCI) either as an urgent procedure to open the vessels or as an elective procedure if medical therapy fails.
The term “Protected PCI" refers to a coronary intervention that is offered in conjunction with a mechanical pump to help support the heart and allow a safer and more complete revascularization procedure. The most common pump utilized in this scenario is the Impella® device, the smallest percutaneous ventricular assist device available. There is data supporting better patient outcomes when Impella® is utilized in a setting of complex coronary anatomy and/or reduced ejection fraction (ref).
The Impella® device has been in use at University Hospitals Harrington Heart & Vascular Institute for several years and UH Cleveland Medical Center is one of 24 national sites participating in a cVAD registry, which tracks utilization and outcomes of all indications for Impella®, beyond Protected PCI.
Specifically in the setting of “Protected PCI," UH continues to demonstrate its national and global leadership by implementing the first system-wide protocol to determine a patient's eligibility for a Protected PCI procedure.
“UH has embraced the concept of Protected PCI to the point that we've determined criteria for use system-wide, which is a first," said Hiram Grando Bezerra, MD, Director of Advanced Coronary Intervention and Mechanical Circulatory Support, UH Harrington Heart & Vascular Institute. “I know of no other programs that have established protocols for use at multiple sites or that have hired a dedicated coordinator like UH has."
Currently, five UH facilities are adopting and offering Protected PCI: UH Cleveland Medical Center, UH Ahuja Medical Center, UH Elyria Medical Center, UH Parma Medical Center and UH St. John Medical Center. In addition, two level 2 labs, UH Geauga and UH Portage medical centers are referring these patients to UH Cleveland Medical Center. The algorithm in use at all sites is shown below.
In her role as Protected PCI research coordinator, Christine Klepek, RN, is working with her peers across the UH system to identify and track the data for implementation of the Protected PCI algorithm:
Mark Kader – UH Ahuja Medical Center
Ellen Hembree – UH Elyria Medical Center
Jeremy Nelson – UH Geauga Medical Center
Chris Luca – UH St. John Medical Center
Marc Streem – UH Portage Medical Center
Dustin Fortier – UH Parma Medical Center
Christine is responsible for the implementation of the multi-disciplinary Protected PCI program at UH. Additionally, since several of these patients have also been considered for bypass, she is focused on appropriate patient identification and selection using a heart team approach and algorithm to provide consistent care and improve outcomes, as well as being the primary resource for patients and families.
Dr. Bezerra describes the benefits to our patients of having a system-wide approach to the Protected PCI procedure. “In the setting of complex anatomy related to potential complications, it becomes a safety net for us," he said. “The traditional term applied in the literature is “high risk PCI," but we prefer calling it “low risk PCI" thanks to the mechanical support along the case. It improves safety for our patients, it helps to ensure the completeness of the procedure, complete revascularization and optimal technique."
For additional information on the Protected PCI treatment or algorithm, please contact Christine Klepek, RN, at 216-844-3801.